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P1.02 - Poster Session/ Treatment of Localized Disease – NSCLC (ID 209)
- Event: WCLC 2015
- Type: Poster
- Track: Treatment of Localized Disease - NSCLC
- Presentations: 1
- Coordinates: 9/07/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
P1.02-009 - Prognostic Value of New IASLC/ATS/RES Lung Adenocarcinoma Classification on Dominate Tumor in Synchronous Multiple Primary Adenocarcinomas (ID 447)
09:30 - 17:00 | Author(s): P. Hsu
The prognostic roles of the dominate tumor and tumor combination pattern in synchronous multiple primary adenocarcinoma (SMPADCs) remain unclear.
The predominant histologic pattern of each tumor among SMPADCs was determined according to the new IASLC/ATS/ERS classification system. For recurrence analysis, each tumor was further divided into low, intermediate and high grade prognostic group. The dominate tumor (DT) was representative of the highest prognostic grade in each SMPADCs.
From 2004 to 2012, there were 108 consecutive nodal-negative patients who underwent surgery for SMPADCs in a tertiary referral center. The median follow-up time was 52.4 months. During follow-up, 38 (35.2%) patients developed recurrence. The pattern of recurrence included local recurrence only in 8 patients (21.1%), distal metastasis only in 11 (28.9%), and both local recurrence and distal metastasis in 19 (50.0%). In multivariate analysis, the percentage of recurrence was significantly higher in older age (p=0.002; odds ratio 6.324) and DT presented with radiologic solid-appearance (vs. pure- , Mixed-GGNs, p=0.032; odds ratio 7.041). In addition, there was no tumor recurrence identified in 17 DTs presented with radiologic pure GGN and 6 DTs in low grade prognostic group. The 5-year overall and disease-free survival of SMPADCs determined by DT in low, intermittent and high grade were 100%, 84.6%, 32.5% (p<0.001) and 100%, 73.9%, 23.3%, respectively (p<0.001). Compared to low/intermediate grade, DT in high grade had significantly worse overall survival (p=0.007; hazard ratio 4.313) and disease-free survival (p=0.045; hazard ratio 2.360) in multivariate analysis. For further combination pattern analysis, high grade DT combined with high grade 2[nd] dominate tumor had significantly worse disease-free survival than that combined with intermediate and low grade 2[nd] dominate tumors.
DT analyzed with prognostic grouping of the IASLC/ATS/RES histological classification was an independent risk factor regarding to overall and disease-free survivals in complete resected nodal-negative SMPADCs. Figure 1
Risks analysis of disease-free survival Variables HR p value HR p value Age 3.212 0.001 2.228 0.026 Gender 1.552 0.182 -- -- Smoking Hx 1.443 0.270 -- -- Preop CEA 1.640 0.217 -- -- Tumor size 2.108 0.024 0.967 0.927 Radiologic appearance 10.814 0.001 3.911 0.086 Pleural invasion 2.069 0.050 0.930 0.869 TNM stage 3.405 0.021 1.334 0.669 Histologic differentiation 4.170 <0.001 1.840 0.118 Angiolymphatic invasion 4.089 <0.001 1.773 0.175 Subtyping predominate 5.399 <0.001 2.360 0.045 Tumor distribution 0.523 0.146 -- -- Same lobe 1.269 0.481 -- -- Adjuvant chemotherapy 1.855 0.072 1.391 0.360 Similar CHS 1.251 0.521 -- --
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